Second edition. David R. Goldmann, Frank H. Brown, and David M. Guarnieri; eds. 741 pages. New York: McGraw-Hill, 1994. $75.00.
Preoperative evaluation and perioperative management of surgical patients are increasingly complex undertakings. As the medical acuity and surgical complexity of patients increase, management of them brings diverse medical specialties into a process that is often unclear about the appropriate role of and knowledge base for the various specialties. This book provides an excellent overview of this area and, although intended for primary care providers and medical specialists, it is also a valuable resource for surgeons and anesthesiologists.
The organization of the book is particularly helpful. Initial chapters about the role of the consultant and appropriate preoperative testing greatly clarify an area of considerable change and controversy; discussion of the relationship of the consultant to the perioperative management team is especially useful. The information in this book is timely and should serve as a guide to appropriate preoperative evaluation and testing.
The section on procedures is comprehensive and considerately provides 1-page synopses for each procedure. These summaries are appropriate as background material for primary care providers; unfortunately, physicians involved in the actual management of surgery and anesthesia will find these summaries and associated tests too brief and sometimes dated. Information about the role of regional anesthesia (in major vascular surgery, for example) does not include indications associated with changes in coagulation and stress response. Laparoscopic and laser surgery are included only in a brief overview that does not sufficiently cover the extensive nature, indications, and complications of these techniques. As would be expected, surgeons and anesthesiologists will need to refer to their own literature in these areas.
Sections on preoperative management, prophylactic therapy, and management of postoperative complications are useful. These are the areas in which internists and subspecialty groups can make the greatest contribution. Each chapter covers a discrete topic, allowing for quick reference by organ system and physiologic state or specific complication. The sections are up-to-date and well written, and they provide all physicians with an excellent guide to navigating patient issues and optimizing patient care. Chapters dealing with postoperative complications not only supply excellent overviews of these areas but provide evidence of the need to include medical specialists in postoperative management, especially in nutrition, management of sepsis, and specific organ function disturbances.
Although many large texts are available on this topic, this book is especially useful for the medical consultant who is involved with perioperative management and for the surgeon, anesthesiologist, and critical care specialist who need a convenient and readable reference on associated medical issues.
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